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Case Reports
. 2023 Sep 30;15(9):e46273.
doi: 10.7759/cureus.46273. eCollection 2023 Sep.

Strangulated Gastric Hernia Following a Missed Traumatic Diaphragmatic Injury: A Case Report

Maria F Guevara-Kissel  1 , Shamon Gumbs  1 , Javier Andrade  2 , Brian Donaldson  1
Affiliations
Case Reports

Strangulated Gastric Hernia Following a Missed Traumatic Diaphragmatic Injury: A Case Report

Maria F Guevara-Kissel et al. Cureus. .

Abstract

Traumatic diaphragmatic injuries (TDIs) are rare and can be life-threatening, depending on the size of the injury and the contents herniating through it. They usually result from blunt or penetrating trauma to the thoracoabdominal area, with an incidence of 0.8-5% and up to 30% presenting late. A high index of suspicion should be maintained when evaluating patients with a history of trauma (severe blunt or thoracoabdominal penetrating trauma) and upper abdominal symptoms. We present a case of a missed TDI after a left posterior thoracoabdominal stab injury, which was evaluated with a diagnostic laparoscopy at an outside hospital. He presented to our emergency department (ED) with sudden onset left-sided chest pain and uncontrollable vomiting. A CT scan was obtained and showed a distended stomach herniating through a defect in the left hemidiaphragm. The patient was immediately taken for laparoscopic exploration and repair. There was a 5 cm defect in the left posterolateral diaphragm containing a strangulated stomach (approximately ⅔) and necrotic omentum. Complete reduction was achieved and the diaphragmatic defect was repaired primarily. His postoperative course was uncomplicated. This case illustrates the importance of maintaining a high index of suspicion for TDI, despite reports of previous exploration. Missed TDI can present with herniated intra-abdominal organs, which can become strangulated and increase morbidity and mortality.

Keywords: diaphragmatic rupture; minimally invasive laparoscopy; missed diagnosis; penetrating abdominal trauma; stomach herniation.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. CXR on the left (six months prior) showing no remarkable findings, and CXR on the right showing an elevated left hemidiaphragm (black arrow).
Figure 2
Figure 2. Coronal view on CT of the abdomen/pelvis points to the herniated stomach.
Figure 3
Figure 3. Intraoperative view of the diaphragmatic defect (arrow).
Figure 4
Figure 4. Intraoperative view showing the ischemic changes of the stomach once reduced intra-abdominally and serosal tears (arrow).
See this image and copyright information in PMC

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